320 S SHIVOM CT (2)� Sg
CITY OF ANAHEIM
Permit Number: SW12022-00038
Issued: 08/03/2022
www.anaheim. net/bu iiding
(714)765-4626
Quarter Section: 208
Site Address: 320 S SHIVOM CT, ANAHEIM, CA 92808
Legal Description: N TR 16632 BLK LOT 1
APN: 35609224
Project Description: New Pool/Spa: 510 sq ft pool with 64 a9 It spa
BUILDING DIVISION
200 S. ANAHEIM BLVD. \
(714) 765 .5153 91
People Associated with Project:
Contractor YORBA RIDGE CONSTRUCTION 20470 VIA TALAVERA201111041037381550 YORBA LINDA, CA 92886
Permit Applicant Gary Anderson
Owner HOTSENPILLER PHILLIP WAYNE 8 TAMARA 320 E SHIVOM CT
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reason(s) Indicated below by the
checkmark(s) I have placed next to the applicable Item(s) (Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to
construct, alto,, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for the permit to file a signed statement that he
or she is licensed pursuant to the provisions of me Contractors' State License Law Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt from Ilcensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($Sec).
❑ I, as owner of property, or my employees with wages as their sole compensation, will do U all or (_) portions of the work, and the structure is not
intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through
employees' or personal efforts, builds or improves the property, provided that the Improvements are not Intended or offered for sale. If, however, the building or
❑ I, as the owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sec. 7044 Business and Professions Code:
The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed
Contractor Dursuant to the Contractor's State License Lawl.
I am exempt from Ilcensure under the Contractors, Stale License Law for the followinq reason:
Date Signature of Property Owner or Authorized Agent
WORKER'S COMPENSATION DECLARATION
I hereby aXinn under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -insure for workers compensation, issued by the Director of Industrial Relations as provided for by
Section 37DO of the Labor Code, for the performance of the work for which this permit is issued.
1 have and will maintain workers compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this
permit Is issued. My workers Compensation insurance carrier and policy are:
Carrier: Policy No.: Expiration Dale:
This section need not be completed If the permit Is for one hundred dollars ($100) or loss.
A3,\\l certify that In the performance of the work for which this permit is Issued. I shall not employ any person in any manner so as to become subject to the
workers compensation laws of California, and agree that, if I should become subject to the workers compensation provisions of Section 3700 of the
Labor Co'L de. I a I�Il.forthwith comoly with those provisions.
pFfYJ3/\ � �
Date Si roof Armikent
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES
AS PROVIDED FOR IN SECTION 3706 OR THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
Lenders Information:
I hereby certify that I have read this application and state that the Information above Is correct. I agree
to comply with all city ordinances and state laws relating building construction, and hereby authorize
representives of this city to enter upon the above mentioned property for Inspection purposes.
The premit shall expire by limitation and become null and void if the building or work has not passed
final inspection 365 days from the date of permit issuance. A new peril is required to commence or
continue work.
I hereby affirm under Penalty of perjury that I am
licensed under provisions of chapter 9 (commencing with
Section 7000) of Division 3 of the Business and
Professions Code.
Date: 08/03/2022
Contractor: YORBA RIDGE CONSTRUCTION
Number: SW12022-OW38 Expiration Date
TYPE: B. C27, C63
Fees paid for Permit: $1.731.03
City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
SWIMMING POOL
ADDRESS:
320 S SHIVOM CT, ANAHEIM, CA 92808
OWNER:
HOTSENPILLER PHILLIP WAYNE a TAMARA
PERMIT#:
SWI2022-00038
DATE ISSUED:
01IM3/2022
DESCRIPTION:
New PoolfSpa: 510 sq it pool with 64 sal it spa
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE ON THE JOB SITE
Inspection
Code
Date
Impactor
1. Main Drain
504
2. Electric Bonding
506
3. Steel
508
4. Approval to Gunite
510
DO NOT GUNITE POOLISPA
until all the above inspections have been signed.
5. BLD-Steel and Electric bonding
(Rock Siructures,Slides Etc)
508
DO NOT GUNITE ROCK STRUCTURE
(water feaure, rock slide, Imams n, waterfall, grow, etc.) until the above inspection has
been signed.
6. Underground Electric
512
$ 2+422
7. Gas Piping Test
514
4a 2W22.
41trif"r
8. P-Trap Receptor
516
9. Backfiow
518
10. Deck, Deck Drains,
Equipotential 8 Accessory
Bondino
520
DO NOT POUR FLATWORK
until all the above Inspections have been signed.
11. Rough Electrical
522
12. Fencing/Door Alarms
524
3-116-23
YI
13. Plaster approval
526
1;.4y2`7j
DO NOT PLASTER
unfit all are above inspections have been signed.
14. Final Electric
1 528 y 3
Sub -Contractors List MUST be approved and pool cover on site
PRIOR to Pool Final inspection request
FINAL INSPECTION
CODE
DATE
INSPECTOR
15. Rough Demo
527
16. Final
599
MISC. INSPECTIONS
Date
Inspector
braoadfons 1.5,
1. All plumbing to be completed and the system pressurized to 35lbs. wish water
or house pressure.
2. All meual Maher 5 fast of pod water, and all pod equipment, mush be bonMed
to pool reMlmang steel wish s8 solk copper wire. Niche light shell, deck inserts,
etc. shall be banded to Pool rater.
3. Pool equipment is not regdred In be set st this time.
Inspection 6.10,
i. Undergmund electric Inspected pwr u backalirg.
2. Gas Ilne test at 1010lor 15 minutes wish 15090uge.
3. When polyethylene gas piping Is used. a wdMate from a certNbd Installer
and tracer wire ahall be provked per CPC 1210.1.7.2 APPENDIX I.
Inspections 1143:
1. Rough electric inspection when all wiring Is completed and ready prior to the
plastering of poollspa. Potting compook in place at plastic light niche.
2. Current Code requires that any pod, spa or water feature
contacting water 18 inches or more in depth shall be enclosed by a banner
adequate W prevent entry of small children. The banner shall comply with
Section 3109 of current C8C and CRC APPDENDIX V specifying Me height of
any fence provided as tamer to Me pod a- shall be 60- above grade on Me
outside of the fence.
3. Doors from a garage shall meet Me requirements for a gate. Glass
windows Milan Sol pool water shall be tempered glass.
4. Prior to pre.plasler inspection. streets, cams and city sidewalks will be
inspecta l for any damage due to construction of pool or spas.
5. Golding complete with positive drainage to street or public way. All
exposed plastic pipe shall be painted to proled from sunlight.
Inspections 14W
L Gas and Elecu l oomplelely removed and 2x2 holes at Whom of Pool
and)or isolated elements.
]. Pool backfiilad:
A.) With fours Wild - sea -compacting sand 95% with receipt.
B I No cure Wild - any fill.
3. After Pool is operating and In working condition with approved pool cover on
site
INSPECTION REQUESTS
Inspection requests made prior to 5:00 pm Monday - Friday
will be scheduled on the following workday.
To schedule your Wilding inspection online, pease go to
to ps:llaca anaheim nat/Qbz,Acoess
Inspection can normally be reached between
7:30 - 8:00 A.M.
(7141765-5153 + 0
To access Your Inspection tlmeTrarrle:
Please go to www anaheim netIcAding after 7:30am of she day of your
Inspection. Under Dolls Services, dick on Me link'Inspecdon
Lmeframes- or call (714) 765-5153 +0
Poldjobcards